1. Field of the Invention
The present invention pertains to suturing of bodily or anatomical tissue and, more particularly, to an instrument having a longitudinal axis and needle holders that extend at an angle to the longitudinal axis for passing a needle through a path that lies at an angle with respect to the longitudinal axis and a method for suturing using the instrument.
2. Description of the Related Art
Suturing of bodily tissue, that is, the practice of using lengths of suture material to ligate or approximate tissue, is a time consuming part of most surgical procedures including open surgery, microsurgery and minimally invasive surgery. "Open surgery" refers to surgery wherein the surgeon gains access to the surgical site by a relatively large incision and "minimally invasive surgery" refers to any type of surgery, such as laporoscopic surgery or "mini-lap" surgery, wherein the surgeon gains access to the surgical site via one or more portals or small incisions through which instruments, such as forceps, cutters, needle holders and the like, are introduced to the surgical site.
In the past, suturing has been accomplished with the use of a sharp suture needle carrying a length of suture material, the suture needle being caused to penetrate and pass through the tissue pulling the suture material through the tissue. Once the suture material has been pulled through the tissue one or more times, the surgeon ties a knot in the suture material. The knot tying procedure allows the surgeon to adjust the tension on the suture material to accommodate the particular tissue being sutured and to control approximation, occlusion, attachment or other conditions of the tissue.
The process of tissue penetration and tying a knot in the suture material can be time consuming and tedious work, particularly when performed in connection with microsurgery and minimally invasive surgery and can unduly prolong the duration of surgery and therefore the period in which the patient is under anesthesia. Nevertheless, minimally invasive surgery is preferred over open surgery due to the greatly reduced trauma and wound healing time for the patient and due to cost savings associated with shorter hospital stays and performing surgery in non-hospital or out-patient surgery sites. Accordingly, there has been much effort to develop techniques for facilitating or replacing the suturing normally performed by use of a suture needle and a length of suture material. Alternative techniques proposed have included electrical coagulation, mechanical devices such as clips, clamps and staples, and lasers. However, no alternative technique has yet been well accepted by surgeons to produce the results obtained by suturing and knot tying. Thus, there is a great need for suturing instruments and techniques useful in minimally invasive and open surgery to permit surgeons to suture anatomical tissue and tie a knot in the suture material using suture needles and lengths of suture material in a time efficient, consistent and precise manner.
The performance of a minimally invasive procedure typically involves creation of one or more puncture sites through a wall of an anatomical cavity using a penetrating instrument including an obturator, such as a trocar, disposed within a portal sleeve. After the penetrating instrument has penetrated into the anatomical cavity, the obturator is withdrawn leaving the sleeve in place to form a portal in the cavity wall for the introduction of instruments, having scissors, forceps, needle holders and the like into the anatomical cavity. The portal sleeve can be omitted and instruments can be inserted through a very small incision.
Suturing is typically performed with a needle holding instrument, or needle holder, having a pair of jaw members adapted to hold the body of a suture needle. The jaw members of the needle holding instrument are inserted into the cavity and are positioned at the operative site by manipulation of a handle at the proximal end of the instrument outside the body. With a suture needle held between the jaw members of the needle holding instrument, the handle is manipulated to cause a tip of the needle to be pushed through the tissue being sutured. Once the tip of the suture needle has been pushed through the tissue, the jaw members of the needle holding instrument must be opened to release the suture needle so that the tip of the needle can be grasped and pulled through the tissue therewith, or, after opening the jaw members, a second needle holding instrument must be introduced at the operative site through another portal to grasp the tip of the suture needle after it has emerged from the tissue being sutured.
The former technique requires difficult manipulation and further adjustment of the suture needle within the jaw members of the needle holder before another stitch can be made. While use of a second needle holding instrument for pulling the needle through the anatomical tissue allows the first needle holding instrument to grasp the body of the suture needle in the manner required to make additional stitches, a second puncture site is required to permit insertion of the second instrument. It is generally desirable to minimize the number of puncture sites created for performing a particular endoscopic procedure.
In minimally invasive procedures or other procedure in which the direction of access to the tissue to be sutured is limited, it is often difficult to suture using conventional instruments and techniques because the angle at which the instrument extends into the cavity is limited. For example, many procedures, such as bladder suspension and vaginal hysterectomy procedures, require suturing to be conducted at various angles. Therefore, it is difficult to accomplish these procedures without multiple puncture sites.